MEDICARE: VLADIMIR MARCELIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	173F00000X	Sleep Specialist (PhD)
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
3	342000000X	Transportation Network Company
4	343800000X	Secured Medical Transport (VAN)
5	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1366214256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VLADIMIR MARCELIN

Provider Business Mailing Address
First Line	:	101 LOCHNAGAR MOUNTAIN DR
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-6674
Country	:	US
Telephone Number	:	484-844-5959
Fax Number	:	720-600-0873

Provider Business Practice Location Address
First Line	:	4319 SALISBURY RD STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-0941
Country	:	US
Telephone Number	:	904-337-1268
Fax Number	:	720-600-0873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/25/2023

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Directions to “ VLADIMIR MARCELIN ” Practice Location

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